title: Implant-based breast reconstruction using a titanium-coated polypropylene mesh (TiLOOP Bra): a multicenter study of 231 cases.
abstract: BACKGROUND
  An alternative to implant-based breast reconstruction using acellular dermal matrix is the use of a titanium-coated polypropylene mesh. The mesh was approved for implant-based breast reconstruction in Europe in 2008, but only limited clinical data are available.
  
  
  METHODS
  Two hundred seven patients (231 breasts) with skin-sparing/nipple-sparing or modified radical mastectomy and immediate or delayed implant-based breast reconstruction using titanium-coated polypropylene mesh were evaluated retrospectively. The primary endpoints were identification of patient-related and surgical factors that were predictive for an adverse outcome and the development of recommendations for patients eligible for implant-based breast reconstruction using the mesh. Complications were divided into major (need for additional surgery), minor (conservative treatment), and implant loss. Univariate and multivariate logistic regression analyses were performed to determine the influence of the patient- and procedure-related characteristics on postoperative complications and implant loss.
  
  
  RESULTS
  No risk factors were observed for patient-associated complications. Major complications occurred in 13.4 percent, minor complications in 15.6 percent, and implant loss in 8.7 percent of patients. Univariate analysis revealed procedure-related risk factors for postoperative complications with a bilateral procedure (p = 0.013) or skin expansion before implant surgery (p = 0.043). Multivariate analysis confirmed these risk factors and revealed an increased risk for implant loss in patients with skin necrosis (p < 0.001) and capsule fibrosis (p < 0.001).
  
  
  CONCLUSIONS
  This titanium-coated polypropylene mesh shows acceptable complication rates and can be a helpful device in implant-based breast reconstruction. The mesh should only be used in primary cases and, when adhering to the proposed indications, is a safe and convenient option in implant-based breast reconstruction.
  
  
  METHODS
  Risk, III.
authors.affiliation: Rostock, Munich, Düsseldorf, Rheinfelden, and Berlin, Germany From the Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock; the Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, Technische Universität München, Roman Herzog Comprehensive Cancer Center; the Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Düsseldorf; Women's Clinic and Breast Center; the Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, Sankt Gertrauden Hospital; the Department of Senology, Vivantes Hospital; and the Department of Senology, Sana Hospital.
authors.forename: Max
authors.initials: M
authors.lastname: Dieterich
authors.forename: Stefan
authors.initials: S
authors.lastname: Paepke
authors.forename: Karin
authors.initials: K
authors.lastname: Zwiefel
authors.forename: Holger
authors.initials: H
authors.lastname: Dieterich
authors.forename: Jens
authors.initials: J
authors.lastname: Blohmer
authors.forename: Andree
authors.initials: A
authors.lastname: Faridi
authors.forename: Evelyn
authors.initials: E
authors.lastname: Klein
authors.forename: Bernd
authors.initials: B
authors.lastname: Gerber
authors.forename: Carolin
authors.initials: C
authors.lastname: Nestle-Kraemling
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery; D020099:Coated Materials, Biocompatible; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D017060:Patient Satisfaction; D011126:Polypropylenes; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013997:Time Factors; D014025:Titanium; D055815:Young Adult
chemical_list: D020099:Coated Materials, Biocompatible; D011126:Polypropylenes; D014025:Titanium